{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T17:07:24Z","timestamp":1774890444103,"version":"3.50.1"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,8,7]],"date-time":"2021-08-07T00:00:00Z","timestamp":1628294400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,8,7]],"date-time":"2021-08-07T00:00:00Z","timestamp":1628294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Fam Pract"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We aim to document the long-term outcomes of ischemic stroke patients and explore the potential risk factors for recurrent cardiovascular events and all-cause mortality in primary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study performed at two general out-patient clinics (GOPCs) under Hospital Authority (HA) in Hong Kong (HK). Ischemic stroke patients with at least two consecutive follow-up visits during the recruitment period (1\/1\u201330\/6\/2010) were included. Patients were followed up regularly till the date of recurrent stroke, cardiovascular event, death or 31\/12\/2018. The primary outcome was the occurrence of recurrent cerebrovascular event including transient ischemic stroke (TIA), ischemic stroke or hemorrhagic stroke. The secondary outcomes were all-cause mortality and coronary artery disease (CAD). We fit cox proportional hazard model adjusting death as competing risk factor to estimate the cause-specific hazard ratio (csHR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 466 patients (mean age, 71.5\u00a0years) were included. During a median follow-up period of 8.7\u00a0years, 158 patients (33.9%) died. Eighty patients (17.2%) had recurrent stroke and 57 (12.2%) patients developed CAD. Age was an independent risk factor for recurrent stroke, CAD and death. Statin therapy at baseline had a protective effect for recurrent stroke (csHR\u2009=\u20090.476; 95% confidence interval [CI] 0.285\u20130.796, P\u2009=\u20090.005) after adjusting death as a competing risk factor and all-cause mortality (HR\u2009=\u20090.693, 95% CI 0.486\u20130.968, P\u2009=\u20090.043). In addition, female sex, antiplatelet and a higher diastolic blood pressure (DBP) at baseline were also independent predictors for survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Long term prognosis of ischemic stroke patients in primary care is favorable. Use of statin was associated with a significant decrease in stroke recurrence and mortality. Patients who died had a significant lower DBP at baseline, highlighted the need to consider both systolic and diastolic blood pressure in our daily practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12875-021-01513-w","type":"journal-article","created":{"date-parts":[[2021,8,7]],"date-time":"2021-08-07T12:02:50Z","timestamp":1628337770000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Long term clinical outcomes of patients with ischemic stroke in primary care \u2013 a 9-year retrospective study"],"prefix":"10.1186","volume":"22","author":[{"given":"Jinghao","family":"Han","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yue Kwan","family":"Choi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wing Kit","family":"Leung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming Tung","family":"Hui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7652-1759","authenticated-orcid":false,"given":"Maria Kwan Wa","family":"Leung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,8,7]]},"reference":[{"key":"1513_CR1","unstructured":"Word Health Organization. The top ten causes of death. Available from:https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/the-top-10-causes-of-death. Accessed 2019 July 27."},{"key":"1513_CR2","unstructured":"Centre for Health protection. Vital Statistics: death rates by leading causes of death, 2001-2018. Department of Health. The government of the Hong Kong Special Administrative Region. Available from: https:\/\/www.chp.gov.hk\/en\/statistics\/data\/10\/27\/117.html. Accessed 27 Jul 2019."},{"issue":"2","key":"1513_CR3","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1161\/01.STR.0000153048.87248.3b","volume":"36","author":"GJ Hankey","year":"2005","unstructured":"Hankey GJ. Secondary prevention of recurrent stroke. Stroke. 2005;36(2):218\u201321.","journal-title":"Stroke"},{"issue":"3","key":"1513_CR4","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1136\/jnnp.2004.038166","volume":"76","author":"J Hata","year":"2005","unstructured":"Hata J, Tanizaki Y, Kiyohara Y, et al. Ten year recurrence after first ever stroke in a Japanese community: the Hisayama study. J Neurol Neurosurg Psychiatry. 2005;76(3):368\u201372.","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"1513_CR5","doi-asserted-by":"crossref","unstructured":"GW Petty, RD Brown, JP Whisnant, et al. Survival and recurrence after first cerebral infarction. A population-based study in Rochester, Minnesota, 1975 through 1989. Neurology. 1998; 50(1): 208\u2013216.","DOI":"10.1212\/WNL.50.1.208"},{"issue":"5","key":"1513_CR6","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1212\/01.wnl.0000201253.93811.f6","volume":"66","author":"MS Dhamoon","year":"2006","unstructured":"Dhamoon MS, Sciacca RR, Rundek T, et al. Recurrent stroke and cardiac risks after first ischemic stroke: the Northern Manhattan Study. Neurology. 2006 Mar 14;66(5):641\u20136.","journal-title":"Neurology"},{"issue":"5","key":"1513_CR7","first-page":"1489","volume":"42","author":"KM Mohan","year":"2011","unstructured":"Mohan KM, Wolfe CD, Rudd AG, et al. Risk and Cumulative Risk of Stroke Recurrence. A Systematic Review and Meta-Analysis Stroke. 2011;42(5):1489\u201394.","journal-title":"A Systematic Review and Meta-Analysis Stroke"},{"issue":"7","key":"1513_CR8","doi-asserted-by":"publisher","first-page":"2160","DOI":"10.1161\/STR.0000000000000024","volume":"45","author":"WN Kernan","year":"2014","unstructured":"Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association. Stroke. 2014;45(7):2160\u2013236.","journal-title":"Stroke"},{"issue":"7329","key":"1513_CR9","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1136\/bmj.324.7329.71","volume":"324","author":"Antithrombotic Trialists' Collaboration","year":"2002","unstructured":"Antithrombotic Trialists\u2019 Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324(7329):71\u201386.","journal-title":"BMJ"},{"issue":"9038","key":"1513_CR10","doi-asserted-by":"publisher","first-page":"1329","DOI":"10.1016\/S0140-6736(96)09457-3","volume":"348","author":"CAPRIE Steering Committee","year":"1996","unstructured":"CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996;348(9038):1329\u201339.","journal-title":"Lancet"},{"key":"1513_CR11","doi-asserted-by":"crossref","unstructured":"Choi YK, Han JH, Li Richard, et al. Implementation of secondary stroke prevention protocol for ischemic stroke patients in primary care. Hong Kong Med J. 2015; 21 (2):136\u2013142.","DOI":"10.12809\/hkmj144236"},{"issue":"11","key":"1513_CR12","doi-asserted-by":"publisher","first-page":"2670","DOI":"10.1093\/ndt\/gft355","volume":"28","author":"M Noordzij","year":"2013","unstructured":"Noordzij M, Leffondr\u00e9 K, van Stralen KJ, et al. When do we need competing risks methods for survival analysis in nephrology? Nephrol Dial Transplant. 2013;28(11):2670\u20137. https:\/\/doi.org\/10.1093\/ndt\/gft355 Epub 2013 Aug 24. PMID: 23975843.","journal-title":"Nephrol Dial Transplant"},{"issue":"446","key":"1513_CR13","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1080\/01621459.1999.10474144","volume":"94","author":"JP Fine","year":"1999","unstructured":"Fine JP, Gray RJ. A Proportional Hazards Model for the Subdistribution of a Competing Risk. J Am Stat Assoc. 1999;94(446):496\u2013509. https:\/\/doi.org\/10.1080\/01621459.1999.10474144.","journal-title":"J Am Stat Assoc"},{"key":"1513_CR14","doi-asserted-by":"crossref","unstructured":"Ka Sing Wong, Huan Li. Long-term mortality and recurrent stroke risk among Chinese stroke patients with predominant intracranial astherosclerosis. Stroke. 2003; 34(10): 2361\u20132366.","DOI":"10.1161\/01.STR.0000089017.90037.7A"},{"issue":"6","key":"1513_CR15","doi-asserted-by":"publisher","first-page":"e560","DOI":"10.1212\/WNL.0000000000006878","volume":"92","author":"RJ Lank","year":"2019","unstructured":"Lank RJ, Lisabeth LD, S\u00e1nchez BN, et al. Recurrent stroke in midlife is associated with not having a primary care physician. Neurology. 2019;92(6):e560\u20136.","journal-title":"Neurology"},{"issue":"8","key":"1513_CR16","doi-asserted-by":"publisher","first-page":"1108","DOI":"10.1111\/ene.12438","volume":"21","author":"G Ntaios","year":"2014","unstructured":"Ntaios G, Papavasileiou V, Makaritsis K, et al. Association of ischaemic stroke subtype with long-term cardiovascular events. Eur J Neurol. 2014 Aug;21(8):1108\u201314.","journal-title":"Eur J Neurol"},{"key":"1513_CR17","doi-asserted-by":"crossref","unstructured":"Niska R1, Han B. Statins for secondary cardiovascular disease prevention for older primary care patients. J Natl Med Assoc. 2009; 101(7):705\u2013710.","DOI":"10.1016\/S0027-9684(15)30980-9"},{"issue":"11","key":"1513_CR18","first-page":"e495","volume":"63","author":"F Brown","year":"2017","unstructured":"Brown F, Singer A, Katz A, et al. Statin-prescribing trends for primary and secondary prevention of cardiovascular disease. Can Fam Physician. 2017;63(11):e495\u2013503.","journal-title":"Can Fam Physician"},{"issue":"4","key":"1513_CR19","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1111\/j.1365-2710.2011.01318.x","volume":"37","author":"A Sicras-Mainar","year":"2012","unstructured":"Sicras-Mainar A, Planas-Comes A, Frias-Garrido X, et al. Statins after recent stroke reduces recurrence and improves survival in an aging Mediterranean population without known coronary heart disease. J Clin Pharm Ther. 2012;37(4):441\u20137.","journal-title":"J Clin Pharm Ther"},{"key":"1513_CR20","doi-asserted-by":"crossref","unstructured":"Amarenco P1, Bogousslavsky J, Callahan A 3rd,et al. Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006;355(6):549\u2013559.","DOI":"10.1056\/NEJMoa061894"},{"issue":"15","key":"1513_CR21","doi-asserted-by":"publisher","first-page":"1404","DOI":"10.1161\/CIRCULATIONAHA.115.016183","volume":"132","author":"Emily C. O\u2019Brien","year":"2015","unstructured":"O'Brien EC1, Greiner MA2, Xian Y, et al. Clinical Effectiveness of Statin Therapy After Ischemic Stroke: Primary Results From the Statin Therapeutic Area of the Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) Study. Circulation. 2015;132(15):1404\u20131413.","journal-title":"Circulation"},{"issue":"2","key":"1513_CR22","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1016\/j.atherosclerosis.2013.09.017","volume":"231","author":"N Makihara","year":"2013","unstructured":"Makihara N, Kamouchi M, Hata J, et al. Statins and the risks of stroke recurrence and death after ischemic stroke: the Fukuoka Stroke Registry. Atherosclerosis. 2013;231(2):211\u20135.","journal-title":"Atherosclerosis"},{"key":"1513_CR23","doi-asserted-by":"publisher","first-page":"2723","DOI":"10.1161\/STROKEAHA.117.018140","volume":"10","author":"J Kim","year":"2017","unstructured":"Kim J, Lee HS, Nam CM, et al. Effects of Statin intensity and adherence on the long-term prognosis after acute ischemic stroke. Stroke. 2017;10:2723\u201330.","journal-title":"Stroke"},{"issue":"6","key":"1513_CR24","doi-asserted-by":"publisher","first-page":"1849","DOI":"10.1161\/STROKEAHA.114.005518","volume":"45","author":"JY Choi","year":"2014","unstructured":"Choi JY, Seo WK, Kang SH, et al. Statins Improve survival in patients with cardioembolic stroke. Stroke. 2014 Jun;45(6):1849\u201352.","journal-title":"Stroke"},{"issue":"1","key":"1513_CR25","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1186\/s12872-017-0599-x","volume":"17","author":"CSC Fung","year":"2017","unstructured":"Fung CSC, Wan EYF, Chan AKC, et al. Statin use reduces cardiovascular events and all-cause mortality amongst Chinese patients with type 2 diabetes mellitus: a 5-year cohort study. BMC Cardiovasc Disord. 2017;17(1):166.","journal-title":"BMC Cardiovasc Disord"},{"key":"1513_CR26","doi-asserted-by":"crossref","unstructured":"Eriksson SE. Secondary prophylactic treatment and long-term prognosis after TIA and different subtypes of stroke. A 25-year follow-up hospital-based observational study. Brain Behav. 2016; 7(1): e00603.","DOI":"10.1002\/brb3.603"},{"issue":"10069","key":"1513_CR27","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1016\/S0140-6736(16)30962-X","volume":"389","author":"GJ Hankey","year":"2017","unstructured":"Hankey GJ. Stroke Lancet. 2017;389(10069):641\u201354.","journal-title":"Stroke Lancet"},{"issue":"10017","key":"1513_CR28","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1016\/S0140-6736(15)00805-3","volume":"387","author":"X Xie","year":"2016","unstructured":"Xie X, Atkins E, Lv J, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet. 2016;387(10017):435\u201343.","journal-title":"Lancet"},{"issue":"1","key":"1513_CR29","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1161\/HYPERTENSIONAHA.116.08485","volume":"69","author":"AH Katsanos","year":"2017","unstructured":"Katsanos AH, Filippatou A, Manios E, et al. Blood Pressure Reduction and Secondary Stroke Prevention: A Systematic Review and Metaregression Analysis of Randomized Clinical Trials. Hypertension. 2017 Jan;69(1):171\u20139.","journal-title":"Hypertension"},{"issue":"16","key":"1513_CR30","doi-asserted-by":"publisher","first-page":"1713","DOI":"10.1016\/j.jacc.2016.07.754","volume":"68","author":"JW McEvoy","year":"2016","unstructured":"McEvoy JW, Chen Y, Rawlings A, et al. Diastolic Blood Pressure, Subclinical Myocardial Damage, and Cardiac Events: Implications for Blood Pressure Control. J Am Coll Cardiol. 2016;68(16):1713\u201322.","journal-title":"J Am Coll Cardiol"},{"issue":"10085","key":"1513_CR31","doi-asserted-by":"publisher","first-page":"2226","DOI":"10.1016\/S0140-6736(17)30754-7","volume":"389","author":"M B\u00f6hm","year":"2017","unstructured":"B\u00f6hm M, Schumacher H, Teo KK, et al. Achieved blood pressure and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials. Lancet. 2017;389(10085):2226\u201337.","journal-title":"Lancet"},{"key":"1513_CR32","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.ijcard.2018.04.031","volume":"263","author":"T Tsujimoto","year":"2018","unstructured":"Tsujimoto T, Kajio H. Low diastolic blood pressure and adverse outcomes in heart failure with preserved ejection fraction. Int J Cardiol. 2018;263:69\u201374.","journal-title":"Int J Cardiol"}],"container-title":["BMC Family Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-021-01513-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12875-021-01513-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-021-01513-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,7]],"date-time":"2021-08-07T12:02:58Z","timestamp":1628337778000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcfampract.biomedcentral.com\/articles\/10.1186\/s12875-021-01513-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,7]]},"references-count":32,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1513"],"URL":"https:\/\/doi.org\/10.1186\/s12875-021-01513-w","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-42359\/v1","asserted-by":"object"}]},"ISSN":["1471-2296"],"issn-type":[{"value":"1471-2296","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,7]]},"assertion":[{"value":"23 July 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 July 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 August 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The study was a retrospective cohort study. The study protocol was approved by The Joint Chinese University of Hong Kong \u2013 New Territories East Cluster Clinical Research Ethics Committee (Reference No. 2019.252) under expedited review with waiver of informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publications"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"164"}}